Long-term Health and Economic Impact of Preventing and Reducing Overweight and Obesity in Adolescence

PurposeUsing data from the 2000 National Medical Expenditure Panel Survey and estimates from published studies, this study projected the long-term health and economic impacts of preventing and reducing overweight and obesity in today's adolescents.MethodsWe developed a body mass index progression model to project the impact of a 1% point reduction in both overweight and obese adolescents aged 16–17 years at present on the number of nonoverweight, overweight, and obese adults at age 40 years. We then estimated its impact on the lifetime medical costs and quality-adjusted life years (QALYs) after age 40. Medical costs (in 2007 dollars) and QALYs were discounted to age 17 years.ResultsA 1% point reduction in both overweight and obese adolescents ages 16–17 years at present could reduce the number of obese adults by 52,821 in the future. As a result, lifetime medical care costs after age 40 years would decrease by $586 million and lifetime QALYs would increase by 47,138. In the worst case scenario, the 1% point reduction would lower medical costs by $463 million and increase QALYs by 34,394; in the best case scenario, it would reduce medical costs by $691 million and increase QALYs by 57,149.ConclusionsObesity prevention in adolescents goes beyond its immediate benefits; it can also reduce medical costs and increase QALYs substantially in later life. Therefore, it is important to include long-term health and economic benefits when quantifying the impact of obesity prevention in adolescents.     

Area Deprivation Affects Behavioral Problems of Young Adolescents in Mixed Urban and Rural Areas: The TRAILS Study

PurposeBehavioral problems occur more frequently among adolescents in deprived areas, but most evidence concerns urbanized areas. Our aim was to assess the impact of area deprivation and urbanization on the occurrence and development of behavioral problems among adolescents in a mixed urban and rural area and to examine the contributory factors.MethodsWe obtained data from the first two waves (n = 2,230; mean ages, 11.5 and 13.5 years respectively; response at follow-up, 96.4%) of the TRacking Adolescents' Individual Lives Survey (TRAILS). TRAILS is a prospective study of adolescent mental health in a mixed urban and rural region of the Netherlands. We assessed adolescent behavioral problems using the parent-reported Child Behavior Checklist (CBCL), the adolescent-reported Youth Self-Report (YSR) and the Antisocial Behavior Scale (ABS). Living areas were categorized into tertiles of deprivation. We further collected data on child temperament, perceived rearing style, parental socioeconomic position (education, income and occupation), family composition, and parental mental health history.ResultsAt baseline, adolescents living in the most deprived tertile more frequently had elevated behavioral problem scores than those from the least deprived tertile on the CBCL (11.2% against 7.1%), YSR (11.9% against 6.9%), and ASB (11.5% against 7.4%) (all p < .05). Socioeconomic position explained half of the differences due to area deprivation. Other familial and parental characteristics did not significantly contribute to the explanation of observed area differences.ConclusionsAs in highly urbanized areas, behavioral problems occur more frequently among adolescents in deprived mixed rural and urban areas. Urbanization has little effect on these area differences.     

School Personnel Perspectives on their School’s Implementation of a School-Based Suicide Prevention Program

Youth suicide is a national public health priority, with policymakers highlighting schools as an ideal setting in which to deliver suicide prevention programs. Over the past decade, the number of schools implementing such programs has grown substantially, yet little is known about how successfully such programs are being implemented. This study examines the implementation of a district-wide suicide prevention program through key informant interviews with school personnel. Schools with higher rates of implementing district protocols for at-risk students had an organized system to respond to at-risk students, a process for effectively responding to students who were at-risk for suicide, and strong administrative support. In contrast, schools that had lower rates of implementing district protocols relied on a handful of individuals for suicide prevention activities and had limited administrative support. Attention to organizational factors leading to successful implementation of school-based suicide prevention programs may enhance the role of schools in national adolescent suicide prevention efforts.     

Mapping service activity: the example of childhood obesity schemes in England

Background  

Childhood obesity is high on the policy agenda of wealthier nations, and many interventions have been developed to address it. This work describes an overview of schemes for obese and overweight children and young people in England, and the 'mapping' approach we used.     

A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries

Background  

A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMCI). However, we need to know how and when this comes to be. We examine evidence from randomized control trials (RCT) on CHW interventions in IMCI in LMIC from a realist perspective with the aim to see if they can yield insight into the working of the interventions, when examined from a different perspective.     

Gaseous air pollution and emergency hospital visits for hypertension in Beijing,China: a time-stratified case-crossover study

Background  

A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension.     

男性儿童青少年血清Apelin遗传度及影响因素双生子研究

利用双生子研究分析影响男性儿童青少年血清Apelin的遗传和环境因素,为探讨年龄、体质量指数(BMI)和肥胖在其中的作用提供依据.方法 选择7~18岁男性双生子162名,平均年龄(12.2±3.7)岁,其中同卵双生子100名,异卵双生子62名.利用DNA微卫星多态性鉴定卵性.应用Mx结构方程模型分别计算年龄、BMI及肥胖调整前后Apelin的遗传度,并分析年龄、BMI和肥胖对Apelin的影响.结果 Apelin水平与年龄呈正相关,肥胖组男童Apelin水平低于正常组(P<0.05).Apelin的遗传度为41%,共同环境方差和独特环境方差分别占37%和22%.调整年龄、BMI及肥胖后,遗传方差比例降低.结论 男性儿童青少年Apelin水平与年龄、肥胖度相关.Apelin受遗传和环境因素的共同影响.     

The ethics of screening for group B streptococcus in pregnancy

Group B streptococcus is carried by approximately 25% of the pregnant population. If passed to newborns during labour, it can cause serious illness and death. Currently, a risk-based screening strategy for pregnant women is advised by both the UK Screening Committee and Royal College of Obstetricians. This enables intrapartum antibiotics to be given to reduce the incidence of early onset group B streptococcal disease. The reasons why universal screening has not been adopted into UK practice are examined in this review. The proposal to screen between 35 and 37 weeks has not been shown to have a high enough sensitivity, and many cases occur in preterm infants, prior to the proposed screening gestation. Antibiotic use has risks for both the mother and neonate, and has not been shown to reduce mortality or serious morbidity rates. Incidence of neonatal group B streptococcus is similar to the UK in countries where universal screening has been adopted. For these and other reasons, more research is needed to ensure that the introduction of universal screening will be beneficial, and to resolve the ethical conflicts raised.     

Giant Gartner Duct Cyst and Elevated CA-125

BackgroundGartner duct cysts represent vestigial remnants of the caudal end of the mesonephric (Wolffian) ducts. They are often associated with ureteral and renal abnormalities. In most cases they are solitary, less than 2 cm in diameter. Giant Gartner duct cysts are extremely rare.CaseWe present a girl with a giant Gartner duct cyst, without notable associated abnormalities or pathology, successfully treated by surgical excision. Preoperative aspiration revealed elevated level of CA-125 in the cyst fluid, with normal serum level of the same marker.ConclusionAnalyzing the aspirated fluid for CA-125 may be a useful tool for evaluation of cystic lesions in this region.